Login to Access Video or Poster Abstract: MP40-06
Sources of Funding: None

Introduction

While the impact of patient specific factors, such as Charlson comorbidity index, body mass index (BMI), age, and maximum flow rate on successful postop voiding trial (VT), are well documented, little is known about the impact of concomitant surgery on the VT. Moreover, there is no standard timing or ideal method of conducting a VT. We aim to elucidate the effect of concomitant surgery on postop voiding after rectus fascia (ARF) and midurethral slings (transobturator (TO) and retropubic (RP)).

Methods

This is an IRB approved, retrospective analysis of women who underwent 3 sling types ± concomitant pelvic surgery at our institution from 2004 to 2015. Inclusion criteria were: preop post void residual < 50 mL, no indication for prolonged postop catheter drainage, and no postop retention requiring sling revision. All women had VT the morning after surgery per protocol. At time of VT, all women were using only oral analgesics for pain control. Demographic and perioperative factors were abstracted from the clinic and hospital charts.

Results

Of 1748 women, 1077 (62%) met inclusion criteria (751 RP, 194 TO, 132 ARF). Overall, 876 (81%) women passed the initial voiding trial (RP 81%, TO 86%, ARF 75%). Of 499 women having only sling, 84.6% passed their VT (RP 87.3%, TO 85.3%, 73.5% ARF). ARF was associated with VT failure, while higher BMI was associated with successful VT. Several additional trends emerged. Concomitant abdominal surgery was strongly associated with successful VT, regardless of sling type. The addition of vaginal prolapse repairs to vaginal hysterectomy lowers the chance of successful VT. Increasing the number of compartments repaired vaginally, especially when transvaginal vault suspension is performed, lowers the chance of successful VT. However, colpocleisis is strongly associated with a successful VT. The addition of transvaginal prolapse repairs to laparoscopy and laparoscopic hysterectomy lowers the chance of successful VT (although the number of concomitant prolapse repairs was small). The addition of transvaginal prolapse repairs to robot assisted hysterectomy does not significantly lower the chance of successful VT (although the number of concomitant prolapse repairs was small).

Conclusions

Lower BMI and ARF sling were associated with initial VT failure. The addition of vaginal prolapse repairs to vaginal or laparoscopic hysterectomy decreases the chance for successful VT, while concomitant abdominal or robotic surgery is not associated with VT failure. This information may be useful in constructing a nomogram to identify women who may benefit from additional preoperative counseling and, perhaps, instruction in intermittent catheterization.

Funding

None